Communication between cancer patients, caregivers and oncologists about out-of-pocket spending

Abstract Background Concern about the cost and affordability of cancer drugs is widespread and well known. Even in countries with universal healthcare systems or health insurance for all, additional patient out-of-pocket (OOP) expenses are prevalent. Studies showed that honest communication between oncologists and patients is an important component in alleviating financial burden of cancer care. The study explores patient-caregiver-oncologist communication regarding the affordability of OOP medication and the extent to which this communication is related to families’ financial burden after their loved ones’ death. Methods A cross-sectional survey is conducted in Israel among 491 primary caregivers of deceased cancer patients, Jewish and Arab, in three oncology centers. Results About 43% caregivers said that they and/or the patients had paid OOP for medications during the last half-year of the patient's life. Most (73%) oncologists who suggested an OOP medication hardly asked or did not ask about financial ability and took little or no interest in ability to afford it, 43% hardly explained or did not explain the advantages of an OOP medication, and 52% hardly explained or did not explain any treatment alternatives. A linear regression analysis reveals that older age and female gender are related to less communication about an OOP medication and that better education, greater affluence, and having private health insurance are related to more communication. About 56% of caregivers say that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. A regression analysis revealed that physicians’ interest in their financial ability and in the explanation they gave decreased their burden. Conclusions Discussing and explaining the meaning of OOP payment alleviates the financial burden that families experience. It is crucial to develop and invest in improving oncologists’ education and skills to communicate costs more openly. Key messages Few oncologists took much interest in patients’ ability to afford medications, while most caregivers found OOP payment for medications burdensome. Oncologists’ explanations and interest in patients’ means lightened the burden. Oncologists need to be better educated in speaking about costs.


Background:
The SARS-CoV-2 pandemic put under pressure all the world's health systems, to the point that it was a severe threat to their stability. At the same time, this scenario confirmed the importance of primary health care to guarantee effective care for patients who suffer from complex and chronic diseases. From these considerations and in the light of the funding provided by the European Union for enhancing the health care system in Italy, our working group has decided to analyse various organisational models of Primary Health Care founded around the world to set up innovative Primary care community Centers in Italy, called Community Houses.

Methods:
A scoping review of the international literature was conducted on Pubmed, searching for primary care models based on integration and co-location of services. Each organisational model was then evaluated using different levels of multidimensional integration inspired by the taxonomy work of P. P. Valentijn, such as clinical, professional, organisational, system, functional and normative integration levels.

Results:
The search produced 2053 results, initially screened by title and abstract and, subsequently, by full-text, finally obtaining 116 articles. When a model is characterised by integrating services with external stakeholders, it also presents more integration levels than the others. In particular, these models are, on average, about 20% more likely to have an organisational, functional and normative integration in the model. Moreover, by stratifying for population complexity, we can find an increase in integration levels for populations suffering from chronic diseases with a higher degree of complexity, such as diabetes or cancer.

Conclusions:
From these preliminary results, we can conclude that it is necessary to prefer primary care models with more integration levels to deliver better healthcare for people with complex or chronic diseases, improving the performance of the Health Care System, especially in Italy.

Key messages:
Our work has allowed us to advise the policymakers on a correct reorganisation of the National Health System in Italy employing the European Union funds. The results of this study will be used to organised Primary care community Centers in Italy, called Community Houses, which aim to facilitate the integration and co-location of services.

Methods:
A cross-sectional survey is conducted in Israel among 491 primary caregivers of deceased cancer patients, Jewish and Arab, in three oncology centers.

Results:
About 43% caregivers said that they and/or the patients had paid OOP for medications during the last half-year of the patient's life. Most (73%) oncologists who suggested an OOP medication hardly asked or did not ask about financial ability and took little or no interest in ability to afford it, 43% hardly explained or did not explain the advantages of an OOP medication, and 52% hardly explained or did not explain any treatment alternatives. A linear regression analysis reveals that older age and female gender are related to less communication about an OOP medication and that better education, greater affluence, and having private health insurance are related to more communication. About 56% of caregivers say that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. A regression analysis revealed that physicians' interest in their financial ability and in the explanation they gave decreased their burden.

Conclusions:
Discussing and explaining the meaning of OOP payment alleviates the financial burden that families experience. It is crucial to develop and invest in improving oncologists' education and skills to communicate costs more openly. Key messages: Few oncologists took much interest in patients' ability to afford medications, while most caregivers found OOP payment for medications burdensome.
Oncologists' explanations and interest in patients' means lightened the burden. Oncologists need to be better educated in speaking about costs.
iii316 European Journal of Public Health, Volume 32 Supplement 3, 2022